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CHALLENGES IN PEDIATRIC FOREGUT REPLACEMENTS: AN 11-YEAR SINGLE CENTER EXPERIENCE.
Susana Fortich, Jana E. DeJesus, Aakash Srikanth, Peyton Armstrong, Geetha Radhakrishnan, Ravi Radhakrishnan
*Surgery, University of Texas Medical Branch, Galveston, TX
Introduction:Foregut replacements are performed in the pediatric population for esophageal atresia, long segment strictures resistant to repeated dilations, caustic injuries, and malignancy. The need for foregut replacements has declined due to advances in the management of esophageal atresia and GERD, as well as protective devices on caustic chemical containers. However, given the technical challenges of these procedures, pediatric and general surgeons should be prepared in the case that foregut replacement is required. This case series describes 13 foregut replacements performed between 2013 and 2020.
Methods:Case logs of a pediatric surgeon at an academic medical center were reviewed between December 2013 – December 2024. Cases involving "esophagectomy", "esophageal replacement", "ileocolonic interposition", and "gastric pull-up" were included. Patient charts and operative reports were reviewed.
Results:A total of 10 patients – 6 females and 4 males – underwent 13 foregut replacement procedures in 7 years. Preoperative diagnoses included esophageal atresia (4/10) and esophageal strictures secondary to Steven Johnson Syndrome (
1/10), NEC (
1/10), and caustic injury (4/10). Esophageal replacements utilized ileocolonic conduits in eight cases and a gastric conduit in one case. Two cases required additional gastric interventions: one involved combined esophageal and gastric replacement, and one involved isolated gastric replacement, both treated with ileocolonic conduits. Anastomotic leak was the most common complication (5/13), followed by anastomotic stricture (4/13) and anastomotic dehiscence (1/13). No deaths occurred.
Conclusion:Though rare, foregut replacements in the pediatric population are still required in a number of pathologic cases. Understanding the patient’s clinical history and knowledge of conduit and route options are important for proper management.
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